Image-based multi-scale modelling and validation of radio-frequency ablation in liver tumours.

The treatment of cancerous tumours in the liver remains clinically challenging, despite the wide range of treatment possibilities, including radio-frequency ablation (RFA), high-intensity focused ultrasound and resection, which are currently available. Each has its own advantages and disadvantages. For non- or minimally invasive modalities, such as RFA, considered here, it is difficult to monitor the treatment in vivo. This is particularly problematic in the liver, where large blood vessels act as heat sinks, dissipating delivered heat and shrinking the size of the lesion (the volume damaged by the heat treatment) locally; considerable experience is needed on the part of the clinician to optimize the heat treatment to prevent recurrence. In this paper, we outline our work towards developing a simulation tool kit that could be used both to optimize treatment protocols in advance and to train the less-experienced clinicians for RFA treatment of liver tumours. This tool is based on a comprehensive mathematical model of bio-heat transfer and cell death. We show how simulations of ablations in two pigs, based on individualized imaging data, compare directly with experimentally measured lesion sizes and discuss the likely sources of error and routes towards clinical implementation. This is the first time that such a 'loop' of mathematical modelling and experimental validation in vivo has been performed in this context, and such validation enables us to make quantitative estimates of error.